Donna Jean Gormley, RD

Individual provider Active NPI Registered Dietitian · Stayton, OR

NPI 1295871614 · NPPES record last updated Oct 24, 2007

Key facts

NPI
1295871614
Entity type
Individual (NPI type 1)
Primary specialty
Registered Dietitian 133V00000X
License
772 (OR)
Practice address
1401 N 10TH Ave
Stayton, OR 97383-1311
Phone
(503) 769-4380
Fax
(503) 769-8563
NPI assigned
Jan 30, 2007
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
772ORMDRegistered Dietitian

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 772 OR Yes

Addresses

Primary practice location

1401 N 10TH Ave
Stayton, OR 97383-1311

Mailing address

1401 N 10TH Ave
Stayton, OR 97383-1311
Phone (503) 769-4380

Other providers in Stayton, OR

All providers in Stayton, OR · Registered Dietitian in Oregon

Sources for this page

Verify at the official NPI Registry.